Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Injury. 2019 Mar;50(3):804-810. doi: 10.1016/j.injury.2018.11.022. Epub 2018 Nov 12.
Surgical treatment of the posterior cruciate ligament (PCL) tibial avulsion fracture is challenging due to the deep-seated location of the lesion with complex adjacent anatomy and usually with small-sized bone fragment. We introduce a novel arthroscopic reduction technique using two cross-linked pull-out sutures (2XLPOS) through triple bone tunnels in posterior cruciate ligament (PCL) tibial avulsion fracture. Posterior trans-septal portal was established following the four standard arthroscopic portals. Bilateral margins of the PCL with 1∼2 mm margin from the border were penetrated using suture hook. Fiberwire sling tied with a No. 0 PDS knot was introduced anterior to the PCL by the two posteriorly pulled shuttle sutures. Three bone tunnels were drilled in the inferomedial, inferolateral, and apex edge of the avulsed tibial crater. Each end of the Fiberwire was drawn out through the inferomedial and inferolateral bone tunnel, respectively. Two ends of the No. 0 PDS were drawn out through the apex tunnel by the same manner. Fiberwire was tied on the anteromedial aspect of the proximal tibia with one strand of the No. 0 PDS placed underneath the Fiberwire knot. And, the No. 0 PDS loop was tied to complete cross-linking of pull-out construct. Arthroscopic reduction of PCL tibial insertion avulsion fracture using 2XLPOS technique was performed in eleven patients. Mean range of motion at the first postoperative year was 126.8°. Mean Lysholm score, Tegner activity scale, and IKDC was 69.2, 4.2, and 58.1, respectively. Posterior instability decreased from mean 12.6 mm preoperatively to 3.2 mm at 1-year postoperative follow up. Radiographic union of the fracture site was confirmed in 11 cases. Our new surgical technique yielded good clinical and radiological outcome, and we consider it is unique in utilizing two cross-linked sling type pull-out suture constructs and triple bone tunnels for their passage.
由于病变位置深在，毗邻结构复杂，且通常骨碎片较小，因此后交叉韧带（PCL）胫骨撕脱骨折的手术治疗具有挑战性。我们介绍了一种新的关节镜下复位技术，使用两条交联型拉出缝线（2XLPOS）通过后交叉韧带（PCL）胫骨撕脱骨折的三个骨隧道。建立后隔室经皮通道，该通道位于四个标准关节镜入路之后。使用缝线钩从前交叉韧带（PCL）的两侧边缘穿刺 1∼2 mm 边界。通过两条向后拉动的滑索缝线将带有 No. 0 PDS 结的 Fiberwire 吊带引入 PCL 前方。在撕脱胫骨凹陷的内下、外下和尖端边缘钻三个骨隧道。Fiberwire 的每一端分别通过内下和外下骨隧道引出。通过相同的方法将 No. 0 PDS 的两端通过尖端隧道引出。Fiberwire 在胫骨近端前内侧与 No. 0 PDS 的一根线捆绑，将 No. 0 PDS 线结放在 Fiberwire 线结下方。然后，将 No. 0 PDS 环系紧以完成拉出结构的交联。使用 2XLPOS 技术对 11 例患者进行了后交叉韧带胫骨附着撕脱骨折的关节镜复位。术后第一年的平均活动范围为 126.8°。平均 Lysholm 评分、Tegner 活动量表和 IKDC 分别为 69.2、4.2 和 58.1。术后 1 年随访时，后向不稳定从术前平均 12.6 mm 减少到 3.2 mm。11 例患者均证实骨折部位有影像学愈合。我们的新手术技术产生了良好的临床和影像学结果，我们认为其独特之处在于利用两条交联型吊带式拉出缝线结构和三个骨隧道来进行复位。
